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J Clin Neurosci. 2014 Nov;21(11):1857-65. doi: 10.1016/j.jocn.2014.01.017. Epub 2014 Jun 30.

Therapeutic approaches to disease modifying therapy for multiple sclerosis in adults: an Australian and New Zealand perspective: part 3 treatment practicalities and recommendations. MS Neurology Group of the Australian and New Zealand Association of Neurologists.

Author information

1
School of Medicine, Griffith University, Gold Coast Campus, QLD 4222, Australia; Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia. Electronic address: simon.broadley@griffith.edu.au.
2
Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, Australia.
3
Department of Neurology, The Townsville Hospital, Douglas, QLD, Australia.
4
Department of Neurology and St Vincent's Centre for Applied Medical Research, St Vincent's Hospital, University of New South Wales, Darlinghurst, NSW, Australia.
5
Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia; Department of Neurology, Eastern Health and Monash University, 2/5 Arnold Street, Box Hill VIC 3128, Australia.
6
Westmead Clinical School, University of Sydney, NSW, Australia.
7
South Western Sydney Clinical School, University of New South Wales, NSW, Australia.
8
Centre for Neuromuscular and Neurological Disorders, University of Western Australia, WA, Australia.
9
Hunter Medical Research Institute, The University of Newcastle, New Lambton, NSW, Australia.
10
Department of Neurology, Austin Health, Heidelberg, VIC, Australia.
11
Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.
12
Department of Neurology, Christchurch Hospital, Christchurch, New Zealand.
13
Central Clinical School, University of Sydney, NSW, Australia.
14
School of Medicine, Deakin University, VIC, Australia.
15
Flinders Medical Centre, Flinders University, SA, Australia.
16
Menzies Research Institute, University of Tasmania, TAS, Australia.
17
Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia.
18
University of Queensland Centre for Clinical Research, QLD, Australia.
19
Department of Neurology, Auckland City Hospital, Auckland, New Zealand.

Abstract

In this third and final part of our review of multiple sclerosis (MS) treatment we look at the practical day-to-day management issues that are likely to influence individual treatment decisions. Whilst efficacy is clearly of considerable importance, tolerability and the potential for adverse effects often play a significant role in informing individual patient decisions. Here we review the issues surrounding switching between therapies, and the evidence to assist guiding the choice of therapy to change to and when to change. We review the current level of evidence with regards to the management of women in their child-bearing years with regards to recommendations about treatment during pregnancy and whilst breast feeding. We provide a summary of recommended pre- and post-treatment monitoring for the available therapies and review the evidence with regards to the value of testing for antibodies which are known to be neutralising for some therapies. We review the occurrence of adverse events, both the more common and troublesome effects and those that are less common but have potentially much more serious outcomes. Ways of mitigating these risks and managing the more troublesome adverse effects are also reviewed. Finally, we make specific recommendations with regards to the treatment of MS. It is an exciting time in the world of MS neurology and the prospects for further advances in coming years are high.

KEYWORDS:

Evidence-based medicine; Guideline; Multiple sclerosis; Review; Treatment

PMID:
24993136
DOI:
10.1016/j.jocn.2014.01.017
[Indexed for MEDLINE]

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